By Joni McMurchy, MSN, PMHNP-BC
Kratom is sold in gas stations, smoke shops, and online as a natural way to boost energy, ease pain, or come off opioids. Many people are surprised to learn it can cause real physical dependence, and that stopping can feel a lot like opioid withdrawal. The good news: kratom dependence is treatable, and you do not have to white-knuckle it alone.
What is kratom?
Kratom comes from the leaves of Mitragyna speciosa, a tree native to Southeast Asia. It is sold as powders, capsules, teas, liquid shots, and gummies. In small amounts people describe it as energizing. In larger amounts it is more sedating and pain-relieving.
Kratom is a plant, but "natural" does not mean "harmless." Its two main active compounds, mitragynine and 7-hydroxymitragynine (often called 7-OH), attach to the same mu-opioid receptors in the brain that prescription painkillers do. That is why kratom can relieve pain and lift mood, and also why the body can come to depend on it.
In most of the United States, kratom leaf is sold as an unregulated supplement. That means no one is checking the strength or purity of what is in the package, and two products with similar labels can be very different.
Why concern about kratom is growing
Kratom-related calls to U.S. poison centers rose from 19 in 2010 to 1,242 in 2023, according to a 2026 report in JAMA. Over the same years, cases involving life-threatening effects, disability, or death went from 0 to 158. About 13% of reported exposures had a severe outcome.
Part of the story is a newer kind of product. 7-OH occurs in the kratom leaf only in trace amounts, but concentrated 7-OH tablets, gummies, and shots are far stronger than the plant itself. People who thought they were buying "just kratom" have found themselves dependent on something that behaves much more like a potent opioid.
Where the law stands in Florida
Florida classified concentrated 7-OH as a Schedule I controlled substance by emergency rule in 2025. In June 2026 the state expanded that rule to cover related compounds. Florida Poison Control reported 95 calls involving these products in the first four months of 2026 alone (Florida Phoenix).
At the federal level, the DEA temporarily placed three related compounds in Schedule I in August 2026. A federal order on 7-OH itself is still pending as of this writing (U.S. Department of Justice). These actions target concentrated and synthetic products, not the plain kratom leaf. Rules are changing quickly, so check current law before assuming a product is legal.
One practical point: when a product is suddenly pulled from shelves, people who relied on it daily can go into withdrawal without warning. If that is you, treatment is available.
Health risks of kratom
Not everyone who uses kratom runs into trouble. But the risks are real, and they rise with higher doses, daily use, concentrated products, and mixing kratom with alcohol, sedatives, or other drugs.
Common effects
Agitation or irritability
Fast heart rate and raised blood pressure
Drowsiness or confusion
Nausea and vomiting
Serious effects
Seizures
Slowed or stopped breathing
Dangerous heart rhythm problems
Coma
Effects of long-term use
Liver injury. Kratom has been linked to liver damage, including rare cases of liver failure. Herbal and dietary supplements as a group are now a leading cause of drug-related liver injury in the U.S.
Hormone changes. Reported effects include low testosterone, low thyroid function, and erectile dysfunction.
Other changes. Weight loss, hair loss, and darkening of the skin have been described.
Who is especially vulnerable
Older adults. Poison center data suggest adults over 60 are more likely to have severe outcomes.
Pregnant women and newborns. Pregnant women; talk with your OB provider or prescribers. Babies born to mothers who use kratom regularly can have withdrawal after birth, with irritability, restlessness, vomiting, and trouble feeding.
People taking other medications or substances. Combining kratom with anything that slows the brain or breathing raises overdose risk.
Signs of kratom dependence and withdrawal
Dependence often builds quietly. Many people start with a small amount for energy, pain, or anxiety, and only notice a problem when they try to cut back.
Signs that kratom use has become dependence include:
Needing more to get the same effect (tolerance)
Cravings, or thinking about the next dose
Dosing several times a day to avoid feeling sick
Trying to stop and not being able to
Continuing despite problems with health, money, work, or relationships
Kratom withdrawal looks a lot like opioid withdrawal. Symptoms can include:
Muscle and joint aches
Runny nose, watery eyes, and yawning
Trouble sleeping
Diarrhea and loss of appetite
Chills, fever, or tremor
Anxiety, restlessness, irritability, and low mood
The emotional symptoms are often what pull people back to using. That is not a failure of willpower. It is how dependence works, and it is the reason support makes such a difference.
How kratom dependence is treated
There are no formal clinical guidelines written specifically for kratom use disorder yet. Because kratom acts on opioid receptors, clinicians adapt the well-studied approaches used for opioid use disorder. The research on kratom itself is still mostly case reports and small case series, so good care is individualized, not one-size-fits-all.
It starts with a thorough evaluation
Treatment should never begin with a prescription pad. A careful evaluation comes first, and it shapes everything that follows. It typically covers:
What you use, how much, how often, and for how long
Other substances, including opioids, alcohol, and sedatives
Your medical history, current medications, and any needed lab work
Mental health conditions such as depression, anxiety, or ADHD, which often travel with substance use
Your goals, and what has or has not worked before
One question matters a great deal: is kratom the only opioid-like substance involved, or is there also a history of opioid use? The answer changes which treatments make sense.
Can this be done by telehealth?
Often, yes. Published case reports describe people successfully starting buprenorphine-naloxone at home with telehealth guidance. For many people this removes the biggest barriers to care: travel, time off work, and privacy.
A word about naloxone
The American Psychiatric Association's 2024 harm reduction resource recommends that people who use kratom have naloxone (Narcan) available, especially if they also use alcohol, sedatives, or other substances that slow breathing. Naloxone can reverse an opioid overdose and is available without a prescription.
Please do not try to manage a heavy kratom habit, or treat it with someone else's medication, on your own. Taking buprenorphine at the wrong time can trigger sudden, severe withdrawal. A supervised plan is safer and far more comfortable.
Common questions about kratom
Is kratom an opioid? Kratom is not a classic opioid like oxycodone, but its active compounds act on the same opioid receptors. That is why it can cause tolerance, dependence, and opioid-like withdrawal.
Is kratom addictive? It can be. Regular use can lead to tolerance, cravings, and withdrawal when you stop. Concentrated 7-OH products carry a higher risk than plain leaf.
How long does kratom withdrawal last? The physical symptoms usually last approximately four to seven days and in some cases a week. Sleep problems, low mood, and cravings can linger longer, which is why follow-up support matters.
Can kratom help me get off opioids? Some people try this, but it often means trading one dependence for another, using a product with no quality control. FDA-approved treatments for opioid use disorder are safer and better studied.
Is 7-OH the same as kratom? No. 7-OH is one compound found in tiny amounts in the kratom leaf. Concentrated 7-OH products are far more potent than the plant and are now Schedule I in Florida.
Can kratom dependence be treated through telehealth in Florida? Yes. After a full evaluation, a qualified prescriber can manage withdrawal and ongoing treatment by telehealth, including buprenorphine-naloxone when appropriate.
When to reach out
If you are using kratom or 7-OH every day, have tried to stop and could not, or feel sick when you miss a dose, that is reason enough to talk with someone. You do not need to hit a low point first.
Get emergency help right away for trouble breathing, a seizure, chest pain, or someone who cannot be woken. Call 911. For questions about an exposure, Poison Help is available 24 hours a day at 1-800-222-1222.
At Inner Compass Mind Health, I work with adults across Florida by telehealth. Care begins with a thorough evaluation, so that any treatment, whether medication, therapy, or both, fits your health, your history, and your goals. I treat kratom and opioid dependence alongside the depression, anxiety, and ADHD that so often sit underneath it, with compassion and without judgment.
Ready to take the next step? Request an appointment at innercompassmindhealth.com.
Joni McMurchy, MSN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner and the founder of Inner Compass Mind Health, providing whole-person psychiatric care to adults throughout Florida.
Sources:
Anderer S. Kratom Use and Severe Health Outcomes Surge in the US. JAMA. 2026.
American Psychiatric Association. Resource Document on Harm Reduction. 2024.
Smith KE, Epstein DH, Weiss ST. Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder. Current Psychiatry Reports. 2024.
Bin Abdullah MFIL. Kratom Dependence and Treatment Options: A Comprehensive Review of the Literature. Current Drug Targets. 2020.
Eastlack SC, Cornett EM, Kaye AD. Kratom: Pharmacology, Clinical Implications, and Outlook. Pain and Therapy. 2020.
Kiyokawa M, Kwon AK, Cape MC, Streltzer JM. Kratom Use Disorder: Case Reports on Successful Treatment With Home Induction of Buprenorphine-Naloxone. Family Practice. 2023.
Eggleston W, Stoppacher R, Suen K, Marraffa JM, Nelson LS. Kratom Use and Toxicities in the United States. Pharmacotherapy. 2019.
Graves JM, Dilley JA, Terpak L, et al. Kratom exposures among older adults reported to U.S. poison centers, 2014-2019. Journal of the American Geriatrics Society. 2021.
Roma K, Mohammed S, Sieck B, Naik K, Wahid S. Kratom-Induced Acute Liver Injury. Journal of Hepatology. 2023.
Florida Phoenix. More 7-OH related products made illegal in Florida by a new emergency rule. June 22, 2026.
U.S. Department of Justice. Updates to emergency scheduling actions on 7-OH and related opioid substances. October 9, 2026.
Drug Enforcement Administration. Temporary Placement of 7-Hydroxymitragynine Above a Specified Threshold in Schedule I (notice of intent). Federal Register. July 6, 2026.
This article is for education only and is not medical advice. It does not replace an evaluation by a licensed clinician. Do not start, stop, or change any medication or supplement without talking with your own healthcare provider. Do not use this information to treat yourself or anyone else. Nothing here is a recommendation to use kratom, 7-OH, buprenorphine-naloxone, or any other substance or medication. Never take a medication that was not prescribed to you. Legal information in this article is not legal advice. Kratom and 7-OH laws are changing quickly and differ by state. The information reflects what was publicly reported as of October 9, 2026, and may be out of date when you read it.
